title: Diagnosis of congenital heart disease in an era of universal prenatal ultrasound screening in southwest Ohio.
abstract: OBJECTIVE
  Diagnostic ultrasound is widespread in obstetric practice, yet many babies with major congenital heart disease remain undiagnosed. Factors affecting prenatal diagnosis of major congenital heart disease are not well understood. This study aims to document prenatal detection rates for major congenital heart disease in the Greater Cincinnati area, and identify factors associated with lack of prenatal diagnosis.
  
  
  METHODS
  All living infants diagnosed with major congenital heart disease by 4 months of age at our centre were prospectively identified. Prenatal care data were obtained by parent interview. Neonatal records were reviewed for postnatal data. Obstetricians were contacted for diagnostic ultrasound data.
  
  
  RESULTS
  A total of 100 infants met the inclusion criteria. In all, 95 infants were analysed, of whom 94 were offered diagnostic ultrasound. In all, 41 had a prenatal diagnosis of major congenital heart disease. The rate of prenatal detection varied by cardiac lesion, with aortic arch abnormalities, semilunar valve abnormalities, and venous anomalies going undetected in this sample. Among subjects without prenatal detection, the highest proportion consisted of those having Level 1 diagnostic ultrasound only (66%). Prenatal detection was not significantly influenced by maternal race, education level, income, or insurance type.
  
  
  CONCLUSIONS
  Despite nearly universal diagnostic ultrasound, detection rates of major congenital heart disease remain low in southwest Ohio. An educational outreach programme including outflow tract sweeps for community-level obstetrical personnel may improve detection rates.
authors.affiliation: 1Department of Pediatrics,Cincinnati Children's Hospital Medical Center,Division of Pediatric Cardiology,The Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: Priya
authors.initials: P
authors.lastname: Sekar
authors.affiliation: 1Department of Pediatrics,Cincinnati Children's Hospital Medical Center,Division of Pediatric Cardiology,The Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: Haleh C
authors.initials: HC
authors.lastname: Heydarian
authors.affiliation: 1Department of Pediatrics,Cincinnati Children's Hospital Medical Center,Division of Pediatric Cardiology,The Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: James F
authors.initials: JF
authors.lastname: Cnota
authors.affiliation: 3Departments of Pediatrics,Division of Pediatric Cardiology and Obstetrics and Gynecology,Fetal & Neonatal Cardiology Program,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Hornberger
authors.affiliation: 1Department of Pediatrics,Cincinnati Children's Hospital Medical Center,Division of Pediatric Cardiology,The Heart Institute,Cincinnati,Ohio,United States of America.
authors.forename: Erik C
authors.initials: EC
authors.lastname: Michelfelder
mesh_terms: D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D009820:Ohio; D011247:Pregnancy; D011295:Prenatal Care; D011296:Prenatal Diagnosis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal / Q000379:methods*